BMJ 1996;312:22-26 (6 January)

Papers

Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial

Michael Sharpe, clinical tutor,a Keith Hawton, senior clinical lecturer,a Sue Simkin, research assistant,a Christina Surawy, research clinical psychologist,a Ann Hackmann, research clinical psychologist,a Ivana Klimes, consultant psychologist,a Tim Peto, consultant physician,b David Warrell, professor of tropical medicine and infectious diseases,b Valerie Seagroatt, statistician c

a University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, b Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, c Unit of Health Care Epidemiology, University of Oxford

Correspondence to: Dr Sharpe.

Abstract

Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome.
Design: Randomised controlled trial with final assessment at 12 months.
Setting: An infectious diseases outpatient clinic.
Subjects: 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome.
Interventions: Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care.
Main outcome measures: The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation.
Results: Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone.
Conclusion: Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.

Key messages

  • Key messages

  • There is no generally accepted form of treatment

  • New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care

  • Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended

  • Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue syndrome


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  • Shepherd, C. (1996). Good general care may offer as much benefit as cognitive behaviour therapy. BMJ 312: 1096a-1096 [Full text]  
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Rapid Responses:

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Cohen's d value for this study has been calculated to be 0.54
Tom Kindlon
bmj.com, 10 Dec 2007 [Full text]
Re: Cohen's d value for this study has been calculated to be 0.54
Tom Kindlon
bmj.com, 27 Dec 2007 [Full text]
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